Comment: Good to see this additional present among the 13 named thus far. It is frustrating, as Integrator columnist Taylor Walsh reports here that the national prevention effort that this Advisory Group is to advise continues to roll forward without the full panel of advisers in place.

A February 2011 note from the American Association of Naturopathic Physicians (AANP) shared thatGuiltinan is expected to take her NACCAM position later this year. She will effectively replace Tim Birdsall, ND, the one ND presently on NACCAM. Guiltinan, dean of naturopathic medicine at Bastyr University, is principally known as a clinician and educator. A trustee since 1998 at Harborview Medical Center, Guiltinan heads up the Naturopathic Physicians Research Education Project, an NCCAM-funded Bastyr grant related to evidence based education. She has held many significant roles for her profession, including president of the AANP.

“The Year in Review for the Policy and Business of the Integrative Practice Community,” a 41-slide presentation I presented on March 5, 2011 is available at this link via the Integrative Healthcare Symposium (IHS). The presentation was part of the well-attended, annual conference in New York City. Most of the slide content was previously reported in past Integrators and will be familiar to close readers. If you have trouble accessing, please let me know and I can send a PDF. Hope this might be useful to some of you. The next IHS conference is February 9-11, 2012.

Cost and Economics

Economic development officials in Asheville, North Carolina explore integrative medicine as a growth opportunity

The March 19, 2011 feature is headlined: “Asheville thrives as regional hub for integrative medicine.” The surrounding county is reportedly home to 32% of the state’s licensed acupuncturists and nearly a half of its licensed massage therapists. The area also includes 30% of the state’s naturopathic physicians and 60% of the American Herbalist Guild members in the state. The article notes that the Institute for Emerging Issues at N.C. State University recently urged that Western North Carolina consider investing in integrative medicine “to generate high-quality jobs.” The topic of integrative medicine was recently one of 11 breakout sessions at the Institute’s 26th annual forum. David Brown, executive director of the Asheville Hub Alliance, an economic development group, notes that “the area has a high concentration of Western and alternative medical providers and the health industry is one of the few areas that has grown during the recession.” He adds: “If you put all these things together, you conclude that Asheville could have a competitive advantage in advancing integrative health.”

“The positive results seen in these studies offer evidence that mind-body approaches to health improvement are an effective and targeted solution for employers who want to lower the costs associated with stress and help their employees achieve better overall health.” The speaker is Kyra Bobinet, MD, MPH, medical director of Health and Wellness Innovation at Aetna, and clinical director of an expanded Aetna study based on two pilots. The studies were developed in collaboration with Duke Integrative Medicine and American Viniyoga Institute (AVI).

A Businesswire release from Aetna shared that early results from randomized controlled pilot studies found significant reductions in stress as compared to the control group. In addition, Aetna’s review of medical claims’ data showed a positive correlation between costs and stress levels. Among the Aetna study volunteers, those reporting the highest level of stress had nearly $2,000 more medical costs annually than those reporting the lowest level of stress. The findings, according to the release, “suggest potential health care costs savings could be realized by reducing stress.” Ruth Wolever, PhD, director of research at the Duke IM program is principal investigator on the study. AVI founder Gary Kraftsow, MA, E-RYT 500 is consulting on the project.

Comment: The Aetna move recalls Mind Matters, Money Matters, the breakthrough article written by Kaiser physician David S. Sobel, MD, MPH over a decade ago. Sobel concluded: “Mind/body medicine is not something separate or peripheral to the main tasks of medical care but should be an integral part of evidence-based, cost-effective, quality health care.” The still slow uptake is likely linked to system discomforts with new players, approaches and patterns of behavior. Credit Aetna for its published commitment.

A comparison between chiropractic and microdiskectomy (low back surgery) found that 60% of those randomized to chiropractic care were able to both avoid surgery and achieve long-term outcomes equal to those who underwent the surgery. Chiropractic care cost roughly $2,000 versus approximately $20,000 for the surgery. The lead author is a chiropractor. The other authors include 3 neurosurgeons. Redwood’s review of the research article is the second piece here. The research citation is McMorland G, Suter E, Casha S, du Plessis SJ, Hurlbert RJ. Manipulation or microdiskectomy for sciatica? A prospective randomized clinical study. J Manipulative Physiol Ther. Oct 2010;33(8):576-584.

$2.75-billion to $3-billion in annual savings in the U.S.?

A follow-up article in Employee Benefits News by Gerald Clum, DC extrapolates from these findings: “In the U.S., at least 200,000 microdiskectomies are performed annually at a direct cost of $5 billion, or $25,000 per procedure. Avoiding 60 percent of these surgeries would mean a reduction savings of $3 billion annually. In the Canadian study, patients receiving chiropractic care averaged 21 visits during their course of care. If a cost of $100 per patient visit is assumed for the care provided by the chiropractor, then the total cost per patient would be $2,100, yielding per patient savings of $22,900, or $2.75 billion dollars annually. The conclusion: $2.75 billion of savings each year if patients used chiropractic treatment first.

Comment: If researchers for a pharmaceutical company or a medical device company had this level of comparative evidence to support the comparative effectiveness of a new approach or product, what do you suppose the response would be? Heck, the benefits are merely positive clinical outcomes plus significant cost-savings. The question this begs is whether integrative practitioners should continue using their breathing and meditation skills to manage their outrage. The lack of significant, proactive response to such results is the context in which to understand that flavor of the recent commentary by Lou Sportelli, DC and Jim Winterstein, DC posted here.

Organizations

Integrative mental health now has a new, international organization to network interested parties: the 501C3 International Network on Integrative Mental Health (INIMH). The group’s formation followed the sold out conference on the topic in March 2010 hosted by the Arizona Center for Integrative Medicine (ACIM). According to a note to the Integrator from one of the lead organizers Sally Dodds, PhD, the Ted and Dr. Roberta Mann Foundation “gave a generous gift for integrative mental health and INIMH was formed.” Says Dodds: “Our main purposes are to advance clinical, research, and professional education in IMH both in the US and internationally.” The organization’s website is expected to go “live” in the next couple of weeks. The next step for the founders is an April 14-16 working retreat hosted by James Duffy, MD and Sierra Tucson (ST), an addiction treatment center situated adjacent to the Miraval Resort. The objectives of the retreat:

Network and collaborate among thought leaders and change agents in IMH.

Learn about the IMH model at ST and obtain feedback from INIMH members on optimizing the model.

Discuss differences between a conceptual model of Integrative Psychiatry and Integrative Mental Health (IMH) and the strengths and limits of each.

Develop a plan and a working group to develop a white paper on IMH as a separate discipline.

Develop a plan and a working group to develop curricula/training projects in IMH, including an interdisciplinary fellowship in Integrative Mental Health at Sierra Tucson.

Develop a plan and a working group to develop an agenda on IMH research priorities.

Develop a plan and a working group to establish model best practice IMH clinical guidelines (for 3 major disorders).

Introduce and demonstrate INIMH website.

Develop a strategy for broadening international representation within INIMH

Comment: This is excellent, important and obviously needed work. How many clients of mental health providers have never been urged to go for a walk? Or swing their arms a bit? Eat well? Take appropriate micronutrients? I look forward to continuing to follow the organization’s work. (Thanks to Patricia Herman, ND, PhD, for linking me to this development.)

The call for nominations for the 2011 Dr. Rogers Prize for Excellence in Complementary and Alternative Medicine has been published. The $250,000 Prize will be awarded Friday, September 23rd, 2011 at a gala dinner in Vancouver, British Columbia. The prize, previously awarded in 2007 and in 2009, is named after pioneering integrative medical doctor Roger Rogers, MD. The day-long celebration includes a Colloquium that is “still in the planning stages but is expected to focus on how integrative medicine is actually practiced in Canada, exploring the successes of a number of integrative clinics from across Canada.”

The nomination deadline for the 2011 competition is May 31, 2011. For those who submitted in the past, the process is simplified. Submissions from 2009 can be accessed online for revision and resubmission. The same esteemed, international set of jurors will decide on the prize winners: James Gordon, George Lewith, Joe Pizzorno, Mary Ann Richardson and Simon Sutcliffe. Also new on the Dr. Rogers Prize site is a gallery with photos from the 2007 and 2009 events. The prize is funded through the Lotte and John Hecht Memorial Foundation.

Academic Medicine

The March 2, 2011 newsletter for the Wake Forest-Baptist Health Center for Integrative Medicine offers a quantitative look at the production of the Center based on grants and projects under way in 2010. The CIM is led by Kathy Kemper, MD, MPH holder of the Caryl J Guth Chair for Integrative Medicine. Ed Shaw, MD is program director for research. A full PDF, available through the newsletter link above, describes these in detail.

Area of activity

Total

Total research grants

112

Total research grant funding

$30,428,527*

Peer-reviewed publications

128(150 faculty involved)

Website visits

28,000

Presentations

139

Participants at presentations

17,000

Media interviews, articles

110

Other funding support

$342,000

Most surprising award

“Supporting Pillarof the Police Department”

* Grant may have been received earlier but work underway during 2010.

Comment: Quite simply, remarkable.

Integration theme propels record turnout for conference of chiropractic educators and researchers

“Outstanding speakers and this year’s theme, integration, propelled us forward to our largest turnout ever for an Association of Chiropractic Colleges-Research Agenda (ACC-RAC) Conference.” So reports David O’Bryon, executive director of the ACC. A total of 463 participants attended. O’Bryon adds that the conference “was a huge success due to the timeliness of and interest in the topics covered. Integrated healthcare is the future and full of opportunities for chiropractic.”

The release from ACC notes that the formal theme was “Integration: Chiropractic Education and Practice in Integrative Healthcare.” One piece of integration was a closing keynote presentation provided by Stephen C. Shannon, DO, MPH, president of the American Association of Colleges of Osteopathic Medicine. Shannon addressed “The Future of Integrative Healthcare: Benefits and Obstacles of Integration.”

Comment: I had an opportunity to participate in this meeting by helping lead a workshop on practical integration. I shared some perspectives on the emerging environment that I later converted into 8 Major Trends Promoting Integration of Integrative Practices and Complementary and Alternative Healthcare Disciplines. In the midst of the ACC-RAC, I began a conversation with a chiropractic clinician with 4 decades of scars from poor relationships with medical doctors. He sees no future in investing in integration, except perhaps among the natural healthcare disciplines. Given the poor inclusion of chiropractic doctors even in most integrative medical settings, it’s no surprise that the purple-ing of the DC-MD bruises is still visible. The slow mainstream response to the evidence on cost and care noted above is yet more fanning of the ire. Good for the ACC to both chose this topic, and then turn out for it in such numbers.

The March 2011 issue of Explore includes an article by publisher Bonnie Horrigan entitled Integrative Medicine Fellowships and Residencies Transforming the Healthcare Landscape. The web-available resource includes information on 4 national programs (e.g. University of Arizona Fellowship, Bravewell) and 12 regional programs (Connecticut, New York, Maine, Michigan, Texas, California, Minnesota, Ohio, Wisconsin and elsewhere). The report offers a short description of each, names core faculty and provides a link.

Comment: This is an excellent resource for not only prospective fellows but also for interested observers of this field. While Horrigan’s title claim that the residencies are “transforming the healthcare landscape” may yet be an aspirational reach, certainly this report signifies integrative medicine’s growing entrenchment in medical education. Horrigan’s article is a fine, useful piece of work. (Thanks to Taylor Walsh for pointing me to this information.)

Fall 2011 will be the first class of a new Master of Science in Nutrition and Integrative Health program at the Tai Sophia Institute. The former single purpose acupuncture program has been expanding its offerings over the past decade. The following are the published “program highlights” of the 47 hour course. The course is structured so that working professionals can take it via weekends over 2 years.

Features custom-designed science courses and core competencies in nutrition assessment and treatment strategies

Includes whole foods cooking as part of academic curriculum

Addresses sustainability and the relationships between our food choices, our agricultural and food processing practices, and the environment

Integrates students into the broader health and wellness learning community at Tai Sophia Institute.

The curriculum is posted here. One interesting feature is a relationship with the Center for Mind-Body Medicine (CMBM) founded by James Gordon, MD. According to an April 6, 2011 e-letter to the CMBM the new course “is very special to us and to Food As Medicine (FAM) graduates.” The reason: “Our own Kathie Swift, MS, RD, our brilliant FAM Curriculum Designer, was one of the visionary leaders in the field who informed the creation of this curriculum.” FAM graduates can receive advanced standing in this degree program.

Professions

Certified Professional Midwives introduce Access to Certified Professional Midwives Act of 2011(HR 1054)

On March 17, 2011 the MAMA Campaign (Midwives and Mothers in Action) for homebirth-oriented midwives sent notice that it is “thrilled to announce that Congresswoman Chellie Pingree (D-ME) has introduced HR 1054, the Access to Certified Professional Midwives Act of 2011 in the U.S. House of Representatives.” HR 1054 would require Medicaid coverage of Certified Professional Midwives (CPMs) who are licensed in the state in which they practice. Said Pingree: “I believe it’s important that women are able to have the birth experience they want, regardless of where they live and how much money they make. That is why it’s important that women with Medicaid coverage have the same access to high quality, safe, and cost-effective services.” Pingree’s co-sponsors are Jim McDermott, MD (D-WA) and Gwen Moore (D-WI).

Comment: The MAMA Campaign had a success its first jump into the Beltway in 2009-2010 when CPMs were included in Section 2301 of the healthcare overhaul bill as covered providers in free-standing birth centers. The group has good evidence of cost-effectiveness. Alignment of interest note: I’m a donor to the campaign due to powerful, transformative homebirth experiences in the birth of each of my children.

American Chiropractic Association priorities under PPACA

A March 24, 2011 e-newsletter to members from the American Chiropractic Association (ACA) notes that the organization’s federal priorities relative to the Obama healthcare overhaul are “to ensure the full applicability of Section 2706 (Provider Non-Discrimination) to insurance plans (including ERISA and state exchange plans) as the primary mechanism through which doctors of chiropractic can provide services in the newly regulated environment created by PPACA.” In addition, the ACA is seeking “to ensure no language is adopted at the federal level relative to ‘essential benefits’ that would specifically exclude the services provided by, or the participation of, chiropractors.”

The AANP’s pitch: Getting out the word on naturopathic medicine

For the small naturopathic medical profession, public relations is a particular need. With just 4000-5000 licensed NDs in the United States, and licensing in just 16 states, few members of the public know what NDs are, or how to find one. A recent membership push from the American Association of Naturopathic Physicians presented naturopathic doctors across the nation with the organization’s bragsheet for what it has accomplished in the public relations area. These extracts offer a sense of both reach, and strategy.

-Organized cadre of ND spokespeople-Engaged firm to help place ND-Developed ND “rapid response team”-Developed ND in the News resource

Comment: As a sometimes executive director involved in growing organizations, and currently presently involved as such, bragsheets are necessary communication tools in building a membership and soliciting support. The high level of consumer use of the website is particularly interesting, as are the organization choices for alliances. It has always stumped me that the organization did not join the Integrated Healthcare Policy Consortium (IHPC), which has worked successfully on many issues of value to its members. My colleague Michael Cronin, ND shares that an affirmative decision was recently made, though the IHPC website does not yet show it.

Media

Cancer wars on Dateline: Follow-up from Clay, Gonzalez, Bryzynski

Lobbyist, former NIH Office of Alternative Medicine staffer and sometimes Integrator contributor Beth Clay sends a note that Dateline NBC recently ran a controversial segment with Suzanne Somers on her book on alternative cancer treatments. Sommers book isKnockOut: Interviews with Doctors Who Are Curing Cancer. Key subjects of the book and Dateline segment were alternative cancer doctors Nicholas Gonzalez, MD and Stanislaw Bryzynski, MD. Barrie Cassileth, PhD, who leads the integrative cancer program at Memorial Sloan Kettering and Andrew Weil, MD, founder of the Arizona Center for Integrative Medicine were each quoted as quite skeptical about the value of the treatments of Bryzynski and Gonzalez.

Following the show, Somers posted lengthy responses to the show from Gonzalez, from Bryzynski and from Clay. While Bryzynski felt the overall interviews with the alternative cancer doctors were “not too bad,” he and Gonzalez and Clay particularly laid into the appropriateness of Cassileth and Weil as experts. The Integrator previously covered some aspects of this long-running dispute in this Round-up.

Comment: Commenting on the therapeutic substance of this battle is well beyond my skill set. However, I do have some background in journalism. This includes working knowledge of how one focuses a story, chooses to include and decides to leave out. This has left me as something of a radical in questioning the journalistic “objectivity” of any participant in this sport. The multiple biases produced through genes, home, culture and environment layer so densely over the imagined balance point to the point of utter obscurity.

The Dateline story and these posts are especially interesting because they focus not only on the macro-cancer wars between mainstream and alternative treatments. We also see here a rather ugly micro-battle between individuals associated with “alternative” and others with “integrative” approaches. My (biased) read: Gonzalez and Bryzynski aren’t getting a fair shake.

Comment on the comment: A working postulate: Battles and bias are most feverish when a) parties are defensive; and b) there is a good deal of cash at stake. Cancer fits both categories. Big money. Big challenges. Everyone talks about how much the other makes, and focuses on the worst of the other’s results. Thus the vehemence.

Miscellaneous

Conference Reports: ACHM, I-Mosaic, Integrative Practice Symposium

The Arizona Center for Integrative Medicine reports that its May 9-11, 2011 Nutrition & Health conference in San Francisco is sold out at 740 paid attendees and over 900 total. The next iteration will be April 15-18, 2012 in Boston … The I-MOSAIC conference led by 4 integrative MD/DO organization is reportedly drawing some 800 to their first conference, in Minnesota … The Integrative Healthcare Symposium held in New York City March 4-6, 2011 drew 1180 participants. Total attendance, including exhibitors, amounted to 1673. Great meeting! (I am pleased to be affiliated with this meeting and organization, an Integrator sponsor.)

Milestone: Reiki’s first appearance in mainstream journal

Reiki maven and connector Pamela Miles shares a milestone for her field: “Our Yale cardiac Reiki study published in the Journal of the American College of Cardiology is the first Reiki study in a conventional medical journal.” Miles is one of the co-authors of the study, led by early Yale integrative medicine organizer Rachel Friedman, entitled Effects of Reiki on Autonomic Activity Early After Acute Coronary Syndrome. (Rachel S.C. Friedman, Matthew M. Burg, Pamela Miles, Forrester Lee, and Rachel Lampert J. Am. Coll. Cardiol. 2010;56;995-996.) According to Miles’ synopsis at her Reiki in Medicine site, researchers found that “patients who received a 20-minute Reiki treatment within three days after suffering a heart attack showed improved mood and heart rate variability (HRV).”

Comment: Two significant questions. First, with something as subtle as Reiki, is it appropriate to measure an achievement as a “milestone”? Second, what will be most excruciating for the anti-IM/CAM bloggers: the report above on the expansion of integrative MD fellowships, or this published account that a Reiki practitioner holding his/her hands a few inches above a person’s body can elicit a clinically meaningful response?

Awards

American Botanical Council and American Herbal Products Association announce awardees

The American Botanical Council and the American Herbal Products Association each announced their annual awards at the major industry gathering at EXPO West in Anaheim in March. This release from ABC offers more details on the following 3 awards:

ABC James A. Duke Excellence in Botanical Literature Award was presented to Aviva Romm, MD, for her new book Botanical Medicine for Women’s Health.

The ABC Norman R. Farnsworth Excellence in Botanical Research Award was presented to Professor A. Douglas Kinghorn, PhD, of Ohio State University.

The ABC Varro E. Tyler Commercial Investment in Phytomedicinal Research Award was presented to New Chapter Inc., a producer of a unique line of dietary supplements.

The AHPA Herbal Hero Award, which recognizes individuals who make outstanding contributions to AHPA committees or initiatives, was awarded to Edward J. Fletcher, chief operating officer of Strategic Sourcing, Inc.

The AHPA Herbal Industry Leader Award, which recognizes companies that set an example of outstanding business practices or organizations that work to move the industry forward above and beyond normal business practices, was awarded to NOW Foods, based in Bloomingdale, Ill.

The AHPA Herbal Insight Award, which recognizes individuals or non-commercial organizations that have a significant impact on furthering knowledge and understanding of botanicals and their uses, was presented to the members of the Expert Advisory Council for the revision to AHPA’s Botanical Safety Handbook.

Special Award: The 2011 AHPA Visionary Award, which recognized unwavering, persistent dedication in the advancement of all-natural stevia, goes to James A. May, CEO of Wisdom Natural Brands of Gilbert, Ariz.

In addition, the Natural Products Association gave one of its 4 Herbal Champion Awards to Frank Lampe, director of communications for AHPA. Lampe, a long-time writer and communications executive, is a founder of the LOHAS concept.

Bastyr’s University community services to the underserved honored by business magazine

“The largest university for natural health arts and sciences in the country, Bastyr University offers free or low-cost naturopathic care to underserved populations in King County through its 15-year-old external site program. Students in advanced naturopathic medicine and acupuncture and Oriental medicine treat patients at 12 locations, including a downtown homeless shelter, a rural community center in Carnation and the Country Doctor Clinic for low-income patients on Seattle’s Capitol Hill. The program reached 3,567 patients in 2009.

In a note to the community, Bastyr’s dean of naturopathic medicine, Jane Guiltinan, ND particularly honored Melissa McCarty, ND, program director and Gary Garcia, MD, MHA, the university’s director of graduate and community medicine.

Comment: A useful data point would be the total number of underserved people who are annually served via schools and programs to clinically educate licensed “CAM” practitioners. A survey with which I was involved via the National Education Dialogue (2005-never published) found a very high percentage of schools had such programs. Bastyr’s was in good company as a runner-up: the other operation similarly noted is the internationally-recognized Airlift Northwest.

People

Brassard chosen as incoming president for the Association of Chiropractic Colleges

Richard G. Brassard, DC, president of Texas Chiropractic College, was elected as incoming president of the Association of Chiropractic Colleges. Brassard, the son of a chiropractor, is a past president of the American Chiropractic Association and has held many leadership positions in his field over the past 40 years. Brassard succeeds Frank Nicchi, DC, MS, president of New York Chiropractic College. Nicchi’s term was marked by a focus on, and advances in, integration. (See article on ACC-RAC conference under Academics, above.) Mark Zeigler, DC, president of the multidisciplinary Northwestern Health Sciences University, will serve as ACC’s vice president.

Israeli integrative medicine doctor, Shay Pintov, leads team to Japan

Georgetown integrative medicine leader Adi Haramati, PhD reports that Shay Pintov, MD, “one of the pioneers of Integrative Medicine in Israel” is serving as the ambassador of an Israel Defense Forces medical mission to Japan. Pintov spent time in Japan after his medical training to learn traditional Japanese Medicine and is bringing that knowledge together with his integrative medicine/pediatrics expertise.

In Memoriam: Michelle Eustache

There was a huge loss to the naturopathic medical profession and, from all accounts, to healing, when 3rd year Bastyr University ND studentMichelle Eustache drowned off the island of Ometepe, Nicaragua, March 25, 2011. Eustache, a second generation Haitian immigrant, was part of a student Brigade participating in a service learning program to delivery clinical and public health services through Natural Doctors International. NDI director Tabatha Parker, ND, told the Integrator that Eustache was “just a natural leader, involved in everything, just a horrible loss.” One example of Eustache’s work is this article on a Bastyr program posted here in which Eustache was a principal. A memory of Eustache is here.

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As the editor of IntegrativePractitioner.com, Lindsay combines her background in digital journalism with her experience in planning the content Integrative Healthcare Symposium conferences. She is an avid traveler and loves to explore new cultures and languages. As a researcher and writer, she embraces the opportunity to explore topics and conversations that are both challenging and exciting, which brought her to the world of integrative medicine. Working together with colleagues and peers across the integrative healthcare community, she is eager to help stimulate important conversations and grow the movement.